Patients will get a better idea of health care costs
Betsy Cliff, The Bend Bulletin
June 25, 2009
A new state law that goes into effect July 1 will help patients better figure out their health care costs.
The law, House Bill 2213, mandates that all of the state’s commercial insurers must set up Web sites and customer service phone lines to give patients cost estimates, including an estimate of the patient’s out-of-pocket costs.
“It’s personalized,” said Randy Cline, the chief operating officer at Clear Choice Health Plans in Bend. “It does give you an estimate based on that specific person’s plan.”
The law requires that if patients give information such as their plan type and the physician they want to see or the hospital they want to use, the insurer’s Web site will estimate that individual’s out-of-pocket expenses. It also mandates that insurers have customer service call lines for the same purpose.
Cline said he and the company were excited about the changes. “It’s definitely the direction we need to go in health care,” he said. “It avoids surprises. It improves patient satisfaction overall.”
Some insurers have previously had some cost tools, though they have generally been less specific — giving information about the average costs of procedures, for example, but not what an individual member might pay.
The law applies to all commercial insurers, with the exception of those companies that act as administrators for self-insured health plans.
It also does not apply to people who get their insurance from the government, such as Medicare or Medicaid beneficiaries, or to those without insurance.
The bill was introduced by the state’s Department of Consumer and Business Services, which contains the state division that regulates insurers. “One of the things we continually hear from consumers is they cannot get a cost estimate for health care services,” said Lisa Morawski, a spokeswoman for the department.
The law, she said, is an effort to remedy that. “Often, (patients) will have a choice of providers or facilities,” said Morawski. “We hope that they will be able to use cost as a factor” in making health care decisions.
The bill requires insurers to give cost estimates for the top five procedures in seven categories: office visits, radiology/imaging, lab procedures, normal vaginal delivery, immunizations, orthopedic surgery and digestive system endoscopy (including colonoscopy).
The estimates come with the caveat that the numbers are just estimates. A procedure may be more involved than a patient thought it would be when inputting information, and complications could lead to more being done. Or, a separate claim could be processed between the time when the patient goes to the Web site and when they get their bill, changing the out-of-pocket cost. For example, a doctor’s appointment might take a month or more to be processed, and if a patient visited the Web site during that time, it would not be reflected in the amount the plan has paid for that patient.
Still, if there are gross discrepancies, said Morawski, patients should call an insurance consumer advocate at the Department of Consumer and Business Services (888-877-4894).
Most insurers are emphasizing new Web sites that give patients instant cost information once they plug in their intended procedure and plan information.
Regence BlueCross BlueShield of Oregon, for example, will debut a new Web site called the Treatment Cost Estimator, where members click through a series of Web sites, first picking a procedure, which generates a list of providers and then showing what each provider would cost the member in out-of-pocket expenses.
The Web site will also allow members to look at providers’ Web sites and read reviews of providers.
HealthNet of Oregon is an exception, said spokeswoman Maggie Huffman. They will have members request cost information via a Web site, have staff research the request and e-mail an answer back. Or, if members use the telephone, she said, will give estimates over the phone.
A phone call, said Huffman, is how the insurer would prefer to talk about costs with members. “We hope that people will use the telephone because of the opportunity to educate them.”
Most insurers supported the bill because of the increased transparency of costs and potential for cost savings. “No one considers (this law) the final say or the ultimate in transparency,” said Michael Becker, the director of legislative and regulatory affairs for Regence. But, he said, “it’s a very, very good step.”
Regence had advocated for other types of transparency through previous legislation, said Becker, and supports this move. “We hope that members will become good purchasers,” he said, which could lower costs for both the patient and the insurer.
“The whole point is to engage the member in trying to manage (their health care) and try to find lower-cost alternatives,” said Bill Hockett, the director of Web strategy for ODS, an Oregon insurer. “It’s there to ultimately save health care costs.”
ADDITIONAL SOURCES: Please check out OAHHS' Price Point database to get hospital cost estimates for various hospital procedures, click here.
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